Healthcare Provider Details

I. General information

NPI: 1952799660
Provider Name (Legal Business Name): ABIGAIL CHRISTINE BENNETT PA-C, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ABBY BENNETT PA-C, LAT, ATC

II. Dates (important events)

Enumeration Date: 01/03/2015
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 OBERLIN RD
RALEIGH NC
27605-1126
US

IV. Provider business mailing address

PO BOX 808800
KANSAS CITY MO
64180-8800
US

V. Phone/Fax

Practice location:
  • Phone: 919-789-4322
  • Fax:
Mailing address:
  • Phone: 919-350-0351
  • Fax: 919-350-7687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-13845
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberLAT-2808
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT5646
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: